Gynaecomastia: causes, diagnosis and treatment in men

What is gynaecomastia?

Gynaecomastia is abnormal growth of glandular breast tissue in men. Unlike an increase caused by a build-up of fat, known as pseudogynaecomastia, here the volume comes from proliferation of glandular tissue, which is sensitive to hormonal imbalance.

The condition has psychological as well as physical consequences. Many patients describe embarrassment, discomfort in everyday situations such as going to the beach or the gym, and a loss of self-confidence.

What causes gynaecomastia

Gynaecomastia can have more than one origin. The commonest causes include:

• Hormonal disorders: an imbalance between testosterone and oestrogen levels, particularly in adolescence, can produce temporary gynaecomastia.
• Medication: certain drugs, such as antiandrogens, antidepressants, anabolic steroids, ulcer treatments and heart medicines, can bring the condition on.
• Substance use: alcohol and other recreational drugs have also been associated with gynaecomastia.
• Underlying illness: liver, kidney, thyroid or testicular disorders can trigger this breast growth.
• Idiopathic factors: in some cases no clear cause is identified.

Telling true gynaecomastia from pseudogynaecomastia is essential, because the treatment depends on which tissue predominates: glandular or fatty.

How is it diagnosed?

The diagnosis of gynaecomastia rests on a clinical examination by a specialist. That assessment should include:

• A full medical history: previous illnesses, medication, lifestyle, family history and associated symptoms.
• Physical examination: palpating the breast tissue to establish whether gland, fat or a combination of the two predominates.
• Further tests: where necessary, hormone blood tests and imaging (breast ultrasound or, in some cases, MRI) are requested to rule out associated conditions or tumours.

Getting the diagnosis right is the key to prescribing the right treatment and to avoiding operations that are unnecessary or insufficient.

When is surgery indicated?

Not every case of gynaecomastia needs surgery. In adolescents, for instance, the breast growth commonly resolves on its own once puberty ends. When the volume does not subside, however, or causes discomfort or interferes with quality of life, surgery is the most effective and definitive option.

Surgery is mainly indicated in these cases:

• gynaecomastia that has persisted for more than 12 months without improving
• gynaecomastia that causes pain, tenderness or swelling
• a significant impact on appearance or on well-being
• no active endocrine disorder, or one that has already been treated

Surgical techniques for correcting it

At the Instituto de Cirugía Plástica del Mediterráneo clinic we use advanced techniques matched to each patient’s anatomy. The options include:

• Glandular excision: a discreet periareolar incision is made to remove the overgrown glandular tissue. This technique is necessary when the gynaecomastia is true, with gland predominating.
• Liposuction: indicated in pseudogynaecomastia or mixed gynaecomastia, it removes the excess localised fat. Access is with fine cannulas through small incisions.
• Combined techniques: many patients have a mixture of fat and gland. In those cases the two techniques are combined to achieve a balanced result.
• Removing spare skin: where there is substantial laxity or loss of skin elasticity, additional skin excision can be carried out to firm the chest.

In cases with little volume, some options can be done under local anaesthetic; in others we add sedation; and for larger procedures the operation is carried out under general anaesthetic. Most cases need no hospital stay, since this is day surgery.

Recovery and results

Recovery after gynaecomastia surgery is generally well tolerated. The patient wears a compression vest for at least four weeks, to control swelling and help the tissues settle.

In the first few days there may be mild discomfort, a feeling of tightness or bruising, which settle with the medication prescribed. A return to work and social life is usually possible at 7 days, while exercise should wait 3 to 4 weeks, particularly anything that works the chest.

The results are visible from the outset, but the final result is reached at 6 months, once the swelling has fully gone and internal healing is complete.

Can it come back?

Gynaecomastia properly treated by surgery does not usually come back. There are, however, factors that can cause fresh glandular growth: anabolic steroid use, hormonal change or untreated illness. That is why a full medical assessment before surgery is essential, as is keeping to healthy habits afterwards.

Risks and things to consider

Like any surgery, correcting gynaecomastia carries risks, although they are uncommon when it is done at a specialist clinic. They include:

• haematoma or seroma
• temporary change in sensation
• asymmetry
• abnormal scarring

Choosing a surgeon experienced in male plastic surgery reduces these risks considerably and improves both functional and aesthetic results.

Why choose a specialist clinic?

Gynaecomastia surgery calls for technical precision, an aesthetic understanding of the male chest and experience with complex cases. At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, we offer a personalised approach. Our specialists assess every case in depth and design an operation specific to each patient.

Our facilities are also equipped with advanced technology, and we have a first-rate surgical and anaesthetic team. Close care, clear information and continuous follow-up mean every patient feels supported before, during and after treatment.

Gynaecomastia is a common condition that can be treated effectively and safely. Surgery restores a firm, symmetrical male chest, improving both physical appearance and self-esteem. If you notice abnormal breast growth, pain or discomfort in the area, see a specialist.

At our clinic in Valencia we offer an accurate diagnosis, a professional approach and lasting results. There is an answer, and it starts with an informative consultation.

Frequently asked questions about gynaecomastia

Does gynaecomastia go away on its own?

Often yes, and that changes the whole approach. Pubertal gynaecomastia resolves spontaneously in 85-90% of cases between six months and two years, and persisting beyond the age of 17 is uncommon.

In an adult, gynaecomastia of recent onset — less than six months — also frequently subsides on its own. So with a new case the right course is usually to investigate the cause and wait, not to operate. Surgery is reserved for gynaecomastia that has been established for some time and has not regressed.

Why have I got it? Is it the fat?

Not always, and telling the two apart matters. True gynaecomastia is growth of glandular tissue; what builds up with excess weight is fat (sometimes called pseudogynaecomastia). Many cases combine the two, and the treatment is not the same.

The commonest causes are puberty itself, being overweight, certain medicines and hormonal disorders. Drugs are estimated to account for between 10% and 25% of all cases.

What is the difference between gynaecomastia and pseudogynaecomastia?

They look alike from the outside and they are not the same. True gynaecomastia is growth of glandular tissue: it feels like a firm disc, sometimes tender, just beneath the nipple. Pseudogynaecomastia is a build-up of fat in the chest, with no enlarged gland, and it is soft and diffuse.

The distinction changes the treatment completely. Fat responds to weight loss and, if needed, to liposuction. Gland responds to none of that: it has to be excised.

Many cases are mixed, which is why examination in the consulting room is what decides, not a photograph.

Will diet and exercise get rid of gynaecomastia?

It depends what you have. If the component is fat, losing weight clearly improves the appearance of the chest, and it is worth trying before considering surgery.

If there is gland, no. It is breast tissue, not fat, and it does not shrink with a calorie deficit or with training. In fact something very frustrating happens: as you slim down and lose the fat around it, the glandular disc becomes more obvious, not less.

Working the chest muscles does not disguise it either: the muscle is underneath, and building it pushes forward whatever is on top of it.

Do anabolic steroids cause gynaecomastia? What if I come off the cycle?

Yes, it is one of the identified causes. Anabolic steroids are partly converted into oestrogens in the body, and that imbalance stimulates breast tissue.

If it is picked up early and use stops, recent growth can regress. But once the tissue has been there for some time it becomes fibrous and no longer reverses, however completely the substance is given up: at that point the only answer is surgical.

It is worth saying plainly and without judgement, because this is information people need in order to decide in time. And it is worth mentioning in the consultation: it affects when to operate, since operating while use is ongoing makes little sense.

Which medicines can cause it?

The list is long and some are in very common use. Those with an established association include spironolactone, cimetidine, ketoconazole, oestrogens, antiandrogens, GnRH analogues and 5-alpha-reductase inhibitors (the ones used for the prostate and for hair loss).

Others with a probable association are risperidone, verapamil, nifedipine, omeprazole, some HIV treatments, anabolic steroids, alcohol and opioids.

Never stop a treatment on your own. But do mention it in the consultation: if the drug is the cause, withdrawing or replacing it under supervision may resolve the problem without surgery.

Can it be a symptom of something serious?

In most cases no, but there are signs that require investigation before anything aesthetic is considered: rapid onset, growth on one side only with a hard or fixed lump, persistent pain, discharge from the nipple, or accompanying symptoms such as weight loss, sexual dysfunction or a change in the sense of smell.

That is why gynaecomastia is first assessed as a medical problem — with examination and, where appropriate, hormone tests and imaging — and only then as a question of contour. Operating without having ruled out a treatable cause is starting at the end.

Are there tablets, or any treatment without surgery?

For established gynaecomastia, no. The clinical guidelines do not generally recommend oestrogen modulators, aromatase inhibitors or androgens to treat it.

What does work is acting on the cause where there is one: withdrawing the drug responsible, treating the underlying hormonal disorder, or dealing with excess weight if the component is fat. And waiting, because many recent cases regress by themselves. Once the tissue has been there a while and has become fibrous, it no longer reverses.

How is it operated on, and what scar does it leave?

It depends on what predominates. If the component is mostly fat, liposuction through millimetre-sized incisions may be enough. If there is gland, it has to be excised, and that requires an incision usually placed at the lower edge of the areola, where the change in colour hides it well.

Where there is a lot of spare skin — typically after major weight loss — it may have to be removed, and then the scars are larger. Most cases combine liposuction and glandular excision in the same operation.

Can it be done with liposuction alone?

Only if the component is essentially fat. Liposuction removes fat effectively and through millimetre-sized incisions, but it does not remove glandular tissue, which is firm and fibrous.

If there is gland and only liposuction is done, the result is characteristic and disappointing: the chest flattens around it but a hard, protruding disc under the nipple remains, sometimes more noticeable than before.

The norm is to combine the two in the same operation: liposuction for the contour, and direct excision of the gland through an incision at the edge of the areola.

How much does gynaecomastia surgery cost?

The price is, as a guide, between 3,000 and 6,500 € (2026), and the range is wide because the cases are. At the lower end are those that can be resolved under local anaesthetic, or in which the component is essentially fat and liposuction is enough. At the upper end, those requiring extensive glandular excision, skin removal and a general anaesthetic.

The quote given after the first consultation is fixed and all-inclusive: operating theatre, anaesthetist, follow-up appointments, compression garment and VAT. Nothing appears on the bill afterwards.

What it does not include are the optional post-operative treatments — radiofrequency, massage or lymphatic drainage — which are recommended according to what each patient needs and are quoted separately.

At what age can gynaecomastia be operated on?

In adolescents the right course is almost always to wait: pubertal gynaecomastia resolves on its own in the great majority of cases between six months and two years. Operating before that means intervening on something that was probably going to disappear.

If it persists beyond the age of 17 or 18 it is unlikely to subside, and surgery can be considered once development is complete.

In adults there is no upper age limit: what is assessed is the state of health and, above all, that a treatable cause has first been ruled out.

How long does recovery take? When can I go back to the gym?

This surgery has a relatively gentle recovery. The norm is to go back to office work quite soon, with discomfort more like severe muscle soreness than sharp pain.

Chest work and lifting weights are the last things to come back, because straining the operated area encourages bleeding and swelling exactly where tissue has been removed. Gentle cardio resumes considerably earlier.

This is one of the operations where impatience shows most: going back to the gym too soon is the commonest reason a haematoma appears or the area ends up uneven.

Will I have to wear a compression garment?

Yes. After surgery a chest compression garment is fitted, worn continuously for the first few weeks and then on a reducing basis.

It is not a minor detail: it reduces swelling, lowers the risk of fluid collecting and, above all, helps the skin adapt to the chest’s new contour. In an area where the skin had to cover a larger volume, that adaptation is a good part of the result.

Your surgeon will set out the specific schedule at your follow-up appointments.

Can it come back after surgery?

If the gland has been excised, that tissue does not grow back. What can return is the fatty component if you put on weight, which is why the result holds better with stable weight.

The other cause of recurrence is not having resolved the underlying reason: if the drug or the hormonal disorder that caused it is still there, the problem can come back. That is another argument for investigating the cause before operating.

And if there is a complication or I need a revision? Who covers it?

Every case is looked at individually, but the general principle is clear. If a medical complication arises, treating it normally involves only the cost of materials and theatre, so the cost is very small compared with a standard operation: the surgery is not charged for again.

As for minor refinement procedures, they are usually included, at minimal cost.

This is not a guarantee of outcome — medicine is an obligation of means, not of results — but an undertaking that, if something requires a second operation, we will make that as straightforward as we possibly can so that any problem can be dealt with.

Sources

The clinical statements on this page are based on the following sources, accessed on 1 August 2026:

• European Academy of Andrology clinical guidelines on evaluation and management: EAA clinical practice guidelines — gynecomastia evaluation and management.
• Clinical evaluation, causes and spontaneous resolution: Gynecomastia: Clinical evaluation and management.
• Drugs associated with gynaecomastia, evidence-based review: Drug-induced gynecomastia: an evidence-based review.
• Aetiology, diagnosis and treatment: Gynecomastia: Etiology, Diagnosis, and Treatment — Endotext.